N g h i e n ctru Y hpc Y Hpc TP. Ho Chi Minh * Tap 21 * So 1 * 2017
KHANG THE IgE DAC HIEU VA XET NGHIEM LAY DA TREN BENH NHAN MAY DAY
Pham Dinh Ldm*, Vdn Thf Trung**
TOMTAT
Mb ddm Mdy day Id mdt binh ly thubng gap, chiem 20% ddn so. Xet nghiim IgE huyei thanh dqc hiiu vd xet nghiem lay da Id cdc xet nghiim quan trgng trong binh ly di umg, giup hqi trie nghi ngb cdc di ling nguyin hd h^ vd di img tie thuc phdm b hinh nhdn mdy day.
Muc tiem Xdc dinh kei qua dieang tinh cua xet nghiem dj iing dqc hiiu vd mSi tuong quan vdi yiii toldm sdng trin binh nhdn mdy day.
Doi tugng vd phucmg phdp: Md td hdng loqt ca trin binh nhdn mdy day tqi Binh vien Dqi hoc Y Duac TpHCM cd xit nghiim IgE huyei thanh dqc hiiu vbi 20 di img nguyin (10 hd hap vd 10 thuc phdm) bang mdy RIDA qLine® Allergy (R-Biapharm AG, Darmstadt, Diic) vd xet nghiim lay da vbi ba di img nguyen tdm, cua, gd.
Kei qud: Gdm 67 binh nhdn mdy day, 55,2% benh nMn co it nhai nwt kei qud IgE huy^ thanh ducmg tinh.
Nhdm di iing nguyen hd hap ducmg tinh 52,2%. Trong dd, mat Blomia Tropicalis diiem 43,2%, mat Dermatophagoides fdrinae 35,8%, mat D.pterony 34,3%. Chi cd 6% benh nhdn mdy day duang tinh vbi di dng nguyen thuc phdm gom bqch tugt, mtfc, tdm, cua, gd vd cd mbi. Xet nghiem lay da chi col tnebng hap duang tinh vbi tdm. Qua phan tich Hdi quy da bieh, ghi nhdn: thbi gian ton tqi thuang ton mdy day emig Wu thi khd nang cd it nhdl mgt kH qud duang tinh trang xet nghiem IgE huy^ thanh dqc hieu cao gap 2,6 ldn (OR = 2,6, CI 95% 1,02 - 6,63, p=0,04). NH gibi cd nguy ca di img zxi mat cao han 4,67 Idn so vbi nam gibi (OR 4,67, CI 95%
1,07 - 20,23, p - 0,04). Nhdm cd miec dd ngiea nqng thi cd nguy ca di Ong zxti mat cao hem nhom ngiea nhe (OR 2,24, CI 95% 1,07-4,65, p = 0,03).
KM luam Ti le Ididng the IgE dqc hiiu dieang tinh vcri mqt Id cao nhdi.Ti le duang tinh zm di Ong nguyen thuc phdm thajj.
Titkhoa: mdy day, xit nghiim khdng the IgE dqc hiiu, xit nghiim ISy da ABSTRACT
SERUM-SPECIFIC IgE MEASUREMENTS AND SKIN PRICK TEST IN URTKZARIA PATIENTS Pham Dinh Lam, Van The Trung * Y Hoe TP. Ho Chi Minh * Vol. 21 - No 1 - 2017:36 - 43 Backgrotmd: Urticaria is a common disorder, zoith a prevalence of approximately 20 percent in the general papulation. Serum-Spedfic IgE measurements and skin prick test are imporiant tools far the clinidan to diagnose allergic sensitization and could exclude a panel cfaeroallergens and susped foods in urticaria patients.
Objectives: to determine the positive results of serum-spedfic IgE measurements and skin pride test and the correlation between these results and clinical symptoms in urticarial patients.
Methods: A case series study of patients zoith urticaria at University Medical Center Ho Chi Minh City.
Diagnosis of urticaria was based on clinical findings. Sera from the patents were analyzed for spedfic IgE antibodies to 20 allergens (10 for inhalant and lOforfxtd panel) by using RIDA qLine® Allergy (R-Biopharm AG, Darmstadt, Germany) and skin prick tests zoere performed zvith 3 food allergens (shrimp, crab and chicken).
* B?nh vien Dai hoc Y Dupe Tp Hb Chi Minh ** Bp mon Da Lilu, DH Y Dupe TP. HCM
Tdc gid liin lac: TS.BS Van The Tnmg DT: 0908282705 Email: [email protected]
36
Y Hpc TP. Hb Chi M i n h * Tap 21 * So 1 * 2017 N g h i e n cihi Y hpc
Results: Sixty-seven urticarial patients were evaluated. More than half of the patients (55.2%) showed a positive reaction to ai least one allergen-spedfic IgE. The positive rate of inhalant allergens was 52.2%.The most commonly detected allergen was Blomia Trapicalis 43.2%, Dermatophagoides farina 35.8% and D. pterony 34.3%. Most patients shaived lower positive reactions to food allergens (6%) including octopus, shrimp, crab, chicken and sardine. Only one patient showed positive with shrimp allergen in skin prick test The relationship between allergen-spedfic IgE positive and urticaria clinical were estimated by using logistic regression. High correlations were found between serum-Spedfic IgE positive and duration of wheals (OR = 2.6, Cl 95% 1.02 - 6.63, p = 0.04); between mites-Spedfic IgE positive and genre (OR 4.67, CI 95% 1.07 - 20.23, p = 0.04); between mites-Spedfic IgE positizK and intensity of pruritus (OR 2.24, CI 95% 1.07 - 4.65, p = 0.03).
Conclusions: Serum-spedfic IgE measurements were highest positizx in inhalant allergens, espedal mites.
Positive rates for response to food allergens were loio.
Key words: Urticaria, serum spedfic IgE mesurements, skin prick test D A T V A N D E
May day gom san phu, mang phu nhat thdri, thuong ngiia va hay tai phat, la b | n h ly thuang g?p, ehiem ti le khoang 20% ciia dan so. Tai benh vien Da Lieu Thanh pho Ho Chi Minh, benh may day diing thii ba sau benh cham va myn tning ca, chiem 37.306 lugt kham trong nam 2014 va tang gap doi so voi nam 2012.
Tai Viet Nam hien da thuc iii^n cae xet nghiem de giiip tim ra di iing nguyen trong cac benh di iing. Theo hirdmg dan eua Hiep hpi Di ling va Mien dich Lam sang Anh quoc (BSACI) ve quan ly may day man tinh va phii mach fhi xet nghiem IgE huyet thanh dae hieu hoac xet nghiem lay da tim cac nguyen nhan dj ling tii thiic an van dupe u u tien hang dau de giup benh nhan loai tru nghi n g a nguyen nhan gay di iing tij ttii^c pham'*'. Cac xet nghiem nay da dugc thue hien tai nhieu ca so y te 6 Viet Nam nhung chua eo nghien ciiu danh gia ket qua dirang tinh cung n h u moi lien quan voi eae yeu to djch te, lam sang ciia b&nh nhan may day.Do do, chiing toi tien hanh nghien eiiu "Khang the IgE dae hieu va xet nghiem lay da tren benh nhan may day".
Muc tieu nghien cmi
Xac dinh ket qua duong tinh cua xet nghiem di iingd?e hieu va moi tuong quan voi yeu to lam sang tren benh nhan may day kham tai Benh vien Dai hoe Y Duge Thanh pho Ho Chi Minh tir
thang 11/2015 dSi thang 4/2016.
DaTUaNG-FHUONGPHAPNGHI^ClJlJ Doi ttrpng nghien cuu
Benh nhan den kham tai B|nh vien Dai hpc Y DugcThanh pho Ho Chi Minh dugc chan doan benh may day qua kham lam sang. Cac benh nhan dugc lam xet nghiem lay da vdi ba dj ling nguyen thue phatn tom, eua, ga va xet nghiem IgE huyet thanh dac hieu voi 20 dj iing nguyen.
Phuong phap nghien ciiu Thiei ke^nghien ciiu
Mo ta hang loat ca.
Cdc bubc tien hdnh
+ Thu Ihap thong tin cae b&ih nhan dugc chah doan may day tren 18 tuoi.
+ Lam xet nghiem lay da voi di iing nguyen tom, eua va ga.
+ Lam xet nghiem huyet thanh IgE d§c hi|u voi 20 di ling nguyen.
-f- Phan tieh so lieu theo phan mem SPSS 16.0 K^T QUA NGHIEN ClTU VA B A N L U A N Dac di^m mau nghien c u u :
Bac diem dich te
MSu nghien eiiu gom 67 benh nhan may day.
Nhom tuoi 30 - 39 tuoi ehiem ti le cao nhat (34,4%) phu hgp vod y van. Theo Fitzpatrick, hai dinh tuoi co tan suat mac benh cao la so sinh d m
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Nghien cxm Y hpc Y Hpc TP. Hb Chi Minh * Tap 21 * So 1 * 2017
9 tuoi va 30-40 tuoi. Trong mau nghien eiiu, nir gioi ehiem 82,4% (51 nguoi) gap 3,19 lan so voi nam gjoi. Chi eo 29,9% benh nhan song tai Thanh pho Ho Chi Minh, con Igi 70,1% song tai eae tinh Ihanh khae.
Bdng 1: Phdn bd'theo nhdm tu^ (N = 67) NlHiintuii
18-29 tu6i 30-39 tuoi 40-49tu6i
^50 tuoi
T i n s d 22 23 14 8
Tilf(%) 32.8%
34.4%
20.9%
11.9%
B^c diein ldm sdng
Co 40,3% benh nhan trong mau nghien ciiu khai CO di iing vai mgt ho^c nhieu loai thiic an.
Trong do, chu yeii la di iing vol torn, cua, ga va cac hai san khac. Tien sii gia dinh bi may day thi CO 26,9% benh nhan trong nhom nghien ciiu co cha me, eon, anh chi em rupt trong gia (Enh bi benh may day. Ti le may day man tinh chiein 64,2% gap doi so vdi may day cap tinh. Chi cd 17,9% berth nhan eo bieu hien phu match kem theo, chu yeu vimg mat va moi.
Bdng 2: Mot sd'dqc diem ldm sdng lien quan dai dd ndng ciia mdy day (N = 67)
E)9Cdi^
l-IOthuwngton 10-20thuwngt6n
>20fhuYyngt6n 1 lan trong ngay 2 - 3 lln trong ngay
> 3 lln trong ngSy Thu&ng tin < 1cm TTiifang tin 1 - 2cm
Thuong tin > 2cm Thirong ton < 4 gid Thuwngtin4-12giD'
Thuwng tin > 12 gi6 Ngi>a nh9 Ngu^ tmng binh
Ngu'a n^ng
Tin s i 37 14 16 24 37 6 21 27 19 44 19 4 21 31 15
TTI|(%) 56.2%
20.9%
23.9%
35.8%
55.2%
9.0%
31,3%
40.3%
28.4%
65.7%
28.4%
5.9%
31.3%
46.3%
22.4%
Cac benh nhan may day trong mau nghien eiiu cd tii 1 den 10 thucmg ton chiem da so 55,2%
va da so ed miie dp ngiia trung binh ehiem ti le 46,3%. Cae thuang ton nay phan ldn eo kich thudc tu 1 Aen 2cm chi&n 40,3%, xuat hien tii 1 deh 3 Ian trong ngay ehiem d ^ da so (91%) va
cac thuang ^m nay ton t ^ tren da diroi 4 gicr chiSn65,7%.
Bdng 3: Phdn bo miec do nang ciia benh theo Breneman vd CS (N=67)
WK dp nang Nhe (1-4 dilm) Tmng binh (5 - 9 dilm)
N|ng(&10dilm)
T i n s d 9 38 20
Tn«(%) 13.8%
56.7%
29,9%
Trong mau nghien oiu, cac benh nhan may day dugc phan logi nhieu nhat la miic dp trung binh chiein 56,7%, ke den la miic dp nang chiem 29,9% truong hgp, va it nhat la miie dp nhe chiem 13,8%.
Ket q u a xet n g h i e m
Xet nghiim huy^ thanh IgE dac hieu Ti ie xet n g ^ e m huy^t thanh IgE co il nhat mpt ket qua duong tinh chiem 55,2%. Trong do, nhdm di iing nguyen ho hap duong tinh ehi&n ti le cao 52,2%, nhdm di iing nguyen thue phain duong tinh chiem ti 1§ thap han 6,0%. Tac gja Nguyen Thi Dieu Thiiy va CS lay mau 6143 tre bi may day cap tinh dirdi 15 tuoi tai benh vi&i Nhi Trung LTong Ha Npi, cd 68 tre duuc lam xet nghiem huyet thanh IgE d|c hieu vdi 20 loai dj ling nguy&n, trong do ed 13 di iing nguyen tiiuc pham va 7 di iing nguyen ho hap. Ket qua dinh lupng khang ftie IgE d^c hieu trong nghien ciiu ciia tae gja Nguyen Thi Dieu Thuy va CS cho thay cd 48,4% tre cd khang the IgE d§c hieu. Ket qua ciia chiing toi phii hgp vdi ket qua ciia tae gia Nguyin Thi Dieu Ihiiy va CS. Tac gia Shin va CS tai Seoul Han Quoc xet nghiem huyet tiianh IgE dae hieu tren 245 benh nhan may day chi cd 37,1% benh nhan cd it nhat mgt ket qua duong tinh, thSp han so vdi ket qua ciia chung toiP). Ket qua duong tinh khong cd khac biet giua benh nhan may day cap tinh va man tinh (38,3%
va 34,2%), giong nhu nghien ciiu ctia chung toi la 58,3% (14/24) va 53,5% (23/43) theo bang 7. Tac gia Chung va CS ghi nhan 51,7% benh nhan xet nghiem huyet thanh IgE d?c hieu ed it nhat mot ket qua duong tinh<^. Ket qua nay gan tuang dong vdi k& qua eiia chiing toi. Ti le duong tinh
Y Hpc TP. Hb Chi Minh * T^p 21 * S b 1 * 2017 N g h i e n cuu Y hpc
nhSn may day man tinh la 495%, khac bi^t cung khong CO y nghia Ihong k^. Ben cgnh dd, van cd ket qua nghien eiiu cao hon nghien ciiu ciia chiing toi. Nghien eiiu cua tac gia Ga tren 707 benh nhan may day m ^ tinh lam xet nghiem huyet thanh IgE dae hieu tren 35 di iing nguyen, cd 78,3% benh nhan duong tinh'^. Tac gia Zeng ngihien a h i tren 437 tre thay rang ti le duong tinh vdi IgE dae hieu la 69,1%'*>. Mgt so tae gia nuac ngoai thpic hien nghien cihi tren tre em va cd ti le ket qua duang tinh cao. Tuy nhien do 6 Viet Nam tre em chii yeu kham tai benh v i ^ Nhi hoac tai phong kham chuyen khoa Nhi, do dd trong nghien a h i nay chiing toi chi chpn lam nghien ciiu tren ngiroi tnrdng thanh. Ket qua nghien ciiu ciia chiing toi giSng nhu ket qua mpt so nghien eiiu khae eho thay nhdm dan so mac benh nhieu nhat la nhdm thanh n i a i tre, nir mac benh may day nhieu hon nam va cd phuong hu6ng giim dan theo nhom tuoi.
Bdng 4: Kei qud ducmg tinh cua xet nghiem huyei thanh IgE dqc hieu tucmg Ong vdi timg loqi di ieng nguyen hd hop (N=67)
Di l>ng nguyin Mat pteranysslnus
Matlarinae Mat blomia Ldngm^o Ldngdid Ldng chu|t Gidn Ling diim
Bui CO B i t
T i n s i 23 24 29 2 0 1 4 1 12 1
Til«(%) 34.3%
35.8%
4 3 i % 3.0%
0.0%
1.5%
6.0%
1.5%
17.9%
1.6%
Trong nhom di iing nguyen ho hap, mat duong tmh voi ti le eao. Mat Blomia Tropicalis dirong tinh vdi ti le cao nhat duOTi 43,2%, ke dSi la mat Dermatophagoides pteronyssinus (34,3%) va mat D.farinae (35,8%). Di iing nguyen ho hap duang tinh vdi ti le cao c h i ^ 52,2% benh nhan may day. Trong nhom di iing nguyen ho hap thi mgt ehiem ti Ie 78,3% rat cao trong nghien ciiu ctia ehiing toi (mat pteronyssinus chi«n 34,3%, mat farinae ehi&n 35,8% va mat blomia chiem 43,2%) con Igi la long chim, long chd, long meo, gian, va byi ed. Theo tae gia Zeng, cac loai dj iing
nguyen Ihuong gap nhat la mat nha (farinae), siia, long did meo. Khang ttie IgE dac hieu hay gap nhat a tre em la mat nha, gap a 86% tre viem miii di iing, 41,2% viem da co dia, 27,6% viem da CO dia va 20% may day. Khang the IgE vdi long did va long meo gap 6 23,5% tre viem da eo dia va 18,1% tre viem da eo dia. Nghien o i u ciia tae gja Zeng ehi ra khang the IgE dac hieu dbi vdi sira, Ihit bo, thit cim tren tre may day dao dbng tir 14 den 24%. Dbi vdi cae di iing nguyen ho hap thi duong tmh d tre dudi 3 tuoi eao hon tre tren 3 tubi, khac biet cd y nghia thbng ke (p < 0,01)(^.
Nghien ciiu ciia tac gia Ga ket qua duong tiiih van chii yeii la mat farinae 31,8%, mat pteronyssinus 24,5%, bui nha 24,0%, long meo 9,3%P). Tac gja Chung va CS ghi nhan, ea benh nhan may day cap tinh va mgn tinh di ling nguyen mat farinae chian ti le eao nhat, ke d m la mat pteronyssinus va bui nha(^>. Tae gia Shin va CS cung ghi nhan trong nhdm cd ket qua duong tfnh, ggp nhieu nhat la mgt farinae 25,9%, thti hai la mat pteronyssinus 22,4%, thii ba la mgt nha 11,4%, thii tu la mugwort 5,7%, thii nam la gian 5,3%, khong co khac biet giiia may day cap tinh va mgn tirii^. Theo tae gia Lee va CS, mgt farinae chiem ti le dirong tinh eao nhat (24,3%) trong cac benh nhan may day man tinh, ke den la mgt pteronyssinus (21,4%), bui nha (7,1%) va tom 4,3%(*>. Cac tac gja deu ghi nhan di ling nguyen hay gap a cac berth nhan cd benh ly da do mien dieh nhu viem da co dia di iing, may day la nhom mat nha gbm mat farinae, mat pteronyssinus. Nhdm mat nay ciing la nguyen nhan ehinh gay nen tinh trgng di iing a cac benh nhan hen va viem mui mgn tinhP*.
Bdng 5: Kit qud duang tinh cua xet nghiem huyet tharih IgE dac hieu tuang Ong vbi timg hqi dj Ong nguyen thuc pham (N=67).
Oi imq nguyen T5m Cua MlfC Cathu Cdmoi CangCi'
T i n s i 1 1 2 1 1 0
Til#(%) 1.5%
1.5%
3.0%
1.6%
1.5%
0.0%
39
Nghi&n citu Y hpc Y Hpc TP. Hb Chi Minh * Tap 21 * Sb 1 * 2017
Dj ijng nguyfin Bd Gi L6ng do tning
Rau
Tansd 0 1 0 1
TII?(%) 0.0%
1.5%
0.0%
1.5%
Trong nhdm di iing nguyen thirc phain, bgch tugc va mue duong tinh 3%, tom, cua, ga deu duong tinh vdi ti le 1,5%. Cac tac gia nude ngoai ghi nhgn ti le duong tinh vdi di iing nguyen thuc pham rat thap. Tac gia Shin vh CS ghi nhSn trong so cac di ling nguyen fhuc pham thi thuong gap nhat la tom, eua, tiep theo la nam mbe, bo va ggof^. Tac gja Chung va CS ghi nhgn cac di iing nguyen thue pham gom dau nanh, ga, nam, ea ngii va ca hbi, chii yeu trong nhdm may day man tinhC'. Theo tac gia Nguyen Thi Dieu Thuy va CS, cd 42,4% duong tinh vdi siia va eae fhanh phan a i a sua, t i ^ d m la ibng ehd, meo 15,2%, mat nha 12,1%; cac di iing nguyen khae ehi&n ti le rat thap^i. Tre em duong tinh nhieu vdi cac di ling nguyen siia, tning va thit bo, con nguoi Ion tH duang tinh nhieu vdi di ling nguyen tom va cua. Ket qua nay cd the dugc giai thich la siia va thit bo la thue pham ehinh trong thai ky tre nho, dan dan dugc dung nap fheo thoi gian, va trong gjai doan trudng fhanh thi dimg nhieu vdi cac sinh vgt bien'''. Ket qua ciia chung toi tuong tu nhu cac nghien ciiu tren th^ gidi, 6 nguoi ldn, di ling nguyen ho hap cao hon di iing nguyen thuc pham. Dieu nay cd the giai thich la benh nhan dan dung ngp vdi di iing nguyen thue pham, trong khi dd, phoi nhiem ngay cang nhieu vdi cac di ling nguyen hd hap mdi*''.
Xet nghiem lay da
Ti le duong tinh eiia cac di iing nguyen fhuc phain trong xet nghiem lay da rat fhap. E>i iing nguy&i tom duong tinh mgt truong hgp ehiem ti le 1,5%, con di iing nguyen eua va ga fhi khong ed trudng hgp nao duong tinh. Kef qua aia duing toi van dang tin cgy vi:
Xet nghiem nay dugc thue h i | n trong benh vien Dai hpe Y Dugc fhanh pho Ho Chi Minh la mgt benh vien ldn, cd uy tin tai fhanh pho Hb
Trong quy trinh lam xet ng^tuem lay da, chiing toi khong sii dung d; iing nguyfen thuc pham tuoi ma chiing toi sii dung bg kit cua hang Stallergenes dugc benh vien daf hang va nhgp khau chinh thiic. Bg kit la san ph&n fhuong mai nen da dugc chuan hda va kiem tra chat lugng tot.
Tat ca cac xet nghiem ISy da deu do cung mgt ky fhuat vien thuc hien. Ky thugt vien nay da dugc dao tao chinh thiic tii nhan vien cua hang Stallergenes va da fhuc hien ky thuat lay da hon ba nam nay.
Ti le duang tinh ciia xet nghiem lay da vdi di ling nguyen thue pham fhap, ma ca mau nghien ciiu ciia chiing toi fhap do gidi han ve mat fhoi gian.
Xet nghiem huyet Ihanh IgE dac hieu eiing ehi cd 1 truang hgp duong tinh vdi tom, tuy nhien hai ket qua nay duong tinh tren hai benh nhan khac nhau.
Tli trudc d m nay, chua cd nghien eiiu va tong ket ve xet nghiem lay da tai Viet Nam. Theo eae tdc gi^ tr&i the gjdi kef qua lay da vdi di iing nguyen fhuc phain eung khong cao. Tac gja Caliskaner nghien o i u tren 259 benh nhan may day mgn tinh dugc lam xet nghiem ISy da vdi 56 di ling nguyen fhuong ggp tai Tho Nhi Ky. Chi ed 27,4% benh nhan cd it nhat mgt ket qua duong tinh, phan ldn la benh nhan may day man tinh duong tinh vcd mat (chiSn 24,7%). Cac di ling nguyen khac dirong tinh khong cao nhu phsii hoa (7,7%), gian (0,8%) d benh nhan may day va khong de cap den di iing nguyen thuc pham (1). Tac gia Ga nghien eiiu tren 304 berth nhan may day mgn tinh cd Iam xet nghiem lay da vdi 54 di iing nguyen, cd 78,3% benh nhan dirong tinh, ket qua ehii yeu duong tinh la mat farinae 52.0%, mgt pteronyssinus 47,7%, gian 27,3%^). Tuy nhim tae gia khong de cap d m ti le dirong tinh voi di ling nguyen fhuc pham. Di ling nguym fhuc pham thay dbi, khac nhau d he em va nguoi ldn. 6 tire em duang tinh vdi di iing nguyen fhuc pham cao hon nguoi ldn va dac
Y H p c TP. H b C h i M i n h * T | p 21 * Sb 1 * 2017 N g h i e n CUTI Y hpc
biet la vdi cac di iing nguy&n siia, tning, thif bo la nguon dinh duong chmh trong thdi ky tho aii, dan dan dugc dung ngp theo thai gian. Cdn nguoi ldn thi duong tinh nhieu vbi di iing nguyen torn, cua do trong giai doan tnrong thanh thi dimg nhieu voi eae sinh vat bimP>.
Chiing toi nhgn thay xet nghiem lay da vin can dugc tiep ti^c nghien o i u de phat huy tinh uu viet ciia nd ben cgnh xet nghiem huyef thanh IgE dac hieu:
Xet nghiem lay da giiip nit ngan thdi gian dib dgi kef qua ciia benh nhan, chi can thai gian 15 phiit la cd kef qua ngay, trong khi lam xet nghiem huyet fhanh IgE dac hieu can hon mpt buoi mdi cd ket qua xet nghiem. Dac biet cac benh nhan den tir eae tinh khac thi xet nghiem lay da phu hgp hem.
Xet nghiem lay da ed chi phi gia thanh fhap hon dio nhiing benh nhan can xac dinh mgt hoge vai di iing nguyen fhuc phain m^ benh nhan nghi nga, trong khi xet nghiem huyef thanh IgE dac hieu phai lam mgt kit 20 di iing nguyen nen ehi phi eao hon.
Benh nhan fhay true tiqj kbt qua xet nghiem nen ciing hieu rd iranh ed dj ling hay khong di ling vdi di iing nguyen ma b^nh nhan nghi ngd lau nay, giiip giai tda tam Iji^ kieng khem eiia ngirdi Vi|t Nam.
Tren the gidi, xet nghi&n lay da duge ehpn lua de danh gia finh trang di iing vdi mpt sb dj ling nguy&i khong fhuong gap ma trong bg kit Iam san ciia xet nghiem huyet thanh IgE dgc hieu khong edei.
Chi phi dau tu Ihap, de dang ap dung eho cac benh vien ldn tai cae tinh fhanh trong ca nudic, giiip benh nhan tim ra dugc die dp an ubng phii hgp va day dii dinh dudng. Xet ngjiiem lay da van dirge xem la xet nghiem dau tien de danh gia dj iing vdi ttutc pham*^, giiip sang loe benh nhan de xac dinh xem cd can lam thii n g ^ e m di ting thiic an qua dudng mieng.
Theo bang 7, cd 40,3% (27/67) benh nhan may day cd di iing vdi tinic an, a i khoang hai ngudi d m kham vi may day flu cd mpt ngudi kieng an. Do dd ket qua xet nghiem khang the IgE dgc hi?u cho di iing nguyen ttiuc phain hay ket qua xet nghiem lay da vdi di iing nguyen thuc pham gdp phan giai tda bdt tam ly cang thang cho b m h nhan may day co n&i tiep tuc kieng nhiing thiic an dge biet dd. Theo hudng dan aia Hiep hgi Di iing va Mien dich Lam sang Anh quoc (BSAQ) ve quan Iy may day man tinh va phu madi thi xet n g h i ^ huyet fhanh IgE dgc hi^u hogc xet nghiem lay da tim cac nguyen nhan di iing fir fhiie an van dugc mi tien hang dau de gjiip benh nhan loai trir nghi ngd nguyen nhan gay di iing tir thue pham'^.
PhSn tich m b i hrong q u a n
Bdng 6: Mdi tuang quan giUa xit nghiim huyii thanh IgE vbi cdc yeii td'dich ti (N = 67) Y l u t l d l c h l l
Tuli GliSitlnh
Dja chi Nam
NO' TpHCM TTnh l(h^c
XN IgE huyit thanh duong dnh N (%) 35.35 ±11.04
7 (19.9%) 30(81.1%) 10 (27%) 27 (73%)
XN IgE huyit Ihanh Im tinh N (%) 36.33 ±11.28
9 (30%) 21 (70%) 10 (33.3%) 20 (66.7%)
P 0.72 (#) 0.29 0 0.57 0 (K) Phep kiSn t (*) Phep kian Chi-Square
Bdng 7: Mm tuang quan giiea xet nghiem huyel thanh IgE dqc hiiu vbi cdc ym toldm sdng (N = 67) Ylu t l lim sdng
Tuli Ithffi p h ^ S i lln mic
binh ThM gian
binh
Lin diu Nhieu lan d p Man
XNIgEhuyltthanhdlKiiigtlnhN(%) 28.81 ±10.14
7 (18.9%) 30(81,1%) 14 (37,8%) 23 (62,2%)
XN IgE huyit thanh9mt'nhN(%) 32.83 ±11.56
5 (16.7%) 26 (83.3%) 10(33.3%) 20(66.7%)
P 0.28 (<Q
0.81 0.71
Nghien ciiu Y hpc
Y H p c T P . H b Chi M i n h * TSp 21 * So 1 * 2017Yeu t l ISm s i n g Phumach Tien SU" gia
dinii
I . . .
So luwng thirong ton
S i lan lap trong ngiy Kich thif 6c thutmg ton TG tin tai thutyng tin
Mik:dQngi>a C<S Khong
C6 Kheng
C6 Kh6ng 1-10 11-20
>20 1 2 - 3
>3
<1 cm 1 - 2 c m
>2cm 1-4gi6' 4 - 1 2 g i d
> 12 gio' Nh$
Tmng binh N|ng
XN IgE huyit thanh duvtig tinh N (%) 8(21.6%) 29(78.4%) 8(21.6%) 29 (78.4%) 15 (40.5%) 22 (59.5%) 18 (48.6%) (24.3%) 10 (27%) 14(37.8%) 21 (56.8%)
2 (6.4%) 7(18.9%) 16 (43.2%) 14 (37.8%) 21 (58.8%) 12 (32.4%) 4(10.8%) 8(21.6%) 20(54.1%) 9(24.3%)
XN IgE huyit thanh am t'nh N (%) 4 (13.3%) 26(86.7%) 10 (33.3%) 20 (66.7%) 12 (40%) 18 (60%) 19 (63.4%) 6(16.7%) 6(20%) 10 (33.3%) 16 (53.3%) 4 (13.3%) 12 (40.0%) 11 (36.7%) 7 (23,3%) 23(76,7%) 7 (23,3%) 0(0%) 13 (43,3%) 11 (36,7%) 6 (20,0%)
P 0,38 0,28 0,96 0,62*
0,62*
0,14*
0,09*
0,17*
Phep kiein Chi-Square (*) Phep hmt Fisher (It) Phep han t Bdng 8 Mdi tucmg quan giOa kB qud xet nghiem huyet thanh IgE ddc hieu vai cdc y&* td'dich ti, lam sdng bdng Hdi quy da bim (N=67)
E)|c dilm Gioi tinh
Dja chi Mic b^iih nhieu
lln Cip/Man Phil mgch Gia dinii d may
day Tien SIT di i>ng TG thutmg tln>
4 gio' M i ^ do ngu'a
nang
Dem bi§n P 0,29 0,57 0,81 0,71 0,38 0,28 0,96 0,09 0.17
OR (CI 95%) 0.59-5,71 0,47-3,86 0,24-3,04 0,30-2,25 0,48-6,66 0,18-1,64 0,38-2,73 0,86-7,28 0,71-6,17
Dabl&n P
0,04 OR (CI 95%)
2.6 (1.02-6.63)
Dan bieh: Phip kiSn Chi-Square, hiih nhi gid Da bi&t: Phdn tich Hoi quy logistic
Qua phan tidi don bim giira cac yeii to didi tl, lam sang vdi xet nghiem huyet thanh IgE dac hieu, ehiing toi ghi nhgn eae khae biet trong ket qua khbng cd f nghia thong ke. Nhimg khi phan tich hbi quy logistic, duing toi ghi nhan thdi gian thuong ton cang lau thi kha nang xet nghiem
khac biet nay cd y nghia fhong ke (p=O,04).
Nhdm benh nhan may day cd thdi gjan Ihuong
^ n keo dai hon 4 gjd ttii kha nang xet nghiem huyet thanh IgE dgc h i ^ cd kef qua duong tinh cao gap 2,6 Kn so vdi nhdm ed thdi gian thuang ton keo dai dudi 4 gid (OR=2,6 va Q 95% la 1,02 - 6,64). Nhu vay fhdi gjan thuong tbn keo dai lien quan vdi xet nghiem huyet thanh IgE dgc hieu duong tinh.
Benh may day xay ra d nii gidi nhieu han nam gidi da dirge nhac nhieu trong cae y van.
Qua phan tieh da bim, chiing toi eung nhan Ihay n u gjdi cd nguy co bi dj iing vdi mat eao gap 4,67 Ian so vdi nam gidi, khae biet ed -f ng^hia thong ke p = 0,04. Kef qua nay chua Ihay y van ghi nhan. Tai Viet Nam, n u gidi lam cdng viee nha nhieu hon nam gjdi, hon niia ttieo bang 1 ed 70,1% (47/67) dan sb sbng d tinh nen n u gjdi tiep xiie nhieu vdi bui mgt nha. Nhdm cd miie do ngiia ngng thi cd nguy co dj iing vdi mgt cao hon nhdm ngiia nhe 2,24 lan, khac biet ed y nghia fhong ke, p = 0,03.
Y Hpc TP. H b Chi M i n h * T^p 21 * S b 1 * 2017 N g h i e n c m i Y h p c
Bdng 9 Mdi tuang quan giUa kil qua xet nghiim huyel thanh IgE dqc hiiu cd nhom mqt dieang tinh zm cdc yeu tff djch ti, ldm sdng bang kdi quy fto bien (N = 67)
Yiu t l dich t l Gidi Hnh
Djach!
Mic b§nh nhilu lln Cap / Man Phumach Gia dinh c6 m ^ day
Tiln si/dj ung TG thmmg t i n > 4 gid'
Mi>c d l n g i ^ nang
Don biin P
0.13 0.47 0.86 0.81 0.16 0.38 0.68 0.12 0.09
OR (CI 95%) 0.75-8.15 0.54-4.53 0,26-3.13 0,41 -3,07 0,69-9,61 0,21-1,84 0,49-3,51 0,80-6,29 0,83-7,86
Da blln P
0,04
0,03
OR (CI 95%) 4,67(1,07-20,23)
2,24(1,07-4,66) Dan biih : Phep kiem Chi-Square, biih nhi gid
KITLUAN
Tl le b m h nhan may day cd if nhat mpt kef qua duong tinh chiem 55,2%.
Nhdm di iing nguyen ho h a p d u a n g tinh ti 1| eao 52,2% so b^nh nhan may day. Mat ehiem ti le rSf cao, mat blomia 43,2%, mat farinae 35,8%, mgt pteronyssinus 34,3%.
Chi cd 6% b m h nhan may day dirong finh vdi di ling n g u y m thyc pham. Mue diiem cao rdnat, ke d m la tom, cua, ga va ea moi.
Xet ngjiiem lay da vdi nhdm thuc pham ti le am tihh eao nen giiip benh nhan logi bd bdt nhiing thiJH: phain an kieng khong can tiiiet.
Qua phan tich hoi quy da b i m , gjii nhan:
I h u o n g t&i hbng ban, san phii ton tai fren da cang lau thi kha nang ed if nhat mbt ket qua duong tmh trong xet ngjiiem IgE huyet thanh dgc hifu cao gap 2,6, khac biet cd y nghia thbng kelanp=0,04.
Nii gidi ed nguy co di iing vdi mat cao h a n 4,67 Ian so vdi nam gidi, khae biet eo y nghia fhdng k e p ^0,04.
Nhdm cd miie do ngiia nang thi ed nguy ea di ling vdi mgt cao hon nhdm ngiia nhe, khac biet cd y nghia fhong ke p = 0,03.
Da biin : Phdn tich Wi quy logistic TAIUEUTHAMKHAO
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2. Chung HC, A h n SK (2015), •Companson of MAST<XA System Results and Allergen Detection Rates between Acute and Chronic Urticana Patients in Gangwon,Yeongseo Province, Korea", J Dermatol, 53 (5), pp. 374-80.
3 Ga YL, H a e YC, M BM, et al. (2010), "Analysis of the results in recent 10 year allei^en test about patients wifli urticaria", Ewha Med J Vol, No.2, p p . 71-80.
4 Lee GY, O w i HY, Myung KB, et al. (2010), "Analyids o£ the Results in Recent 10-year Allergen Test about PaHents with Urticana", Ewha Wfed J Vol, 33 (2), pp. 71-80.
5 N g u y i n H i i Di$u Thuy, Le Thj Minh H u o n g (2013), "Nguy§n nhan may day cap 6 tre em", T s p chi Y HQC TF. H o Chi Minh, l a p l ? , lr.232-4
6 PoweU RJ, Leech S Q Till S, el aL (2015), "BSAO guideline for the management of chronic urtacana a n d angioedema".
Clinical Et Expenmental Allergy, 45, pp. 547-65.
7 Shin JW, Jm SP, Lee JH, et a l (2010), "Analysis of MAST-CLA Results as a Diagnostic Tool in Allergic Skin EHseases", Ann Dermatol 22 (1), pp. 3 5 ^ .
8 Zeng YH, Zhang D, Shu Y, et al. (2009), 'Detection of serum spedBc IgE in 437 children with allergic disease", Zhongguo Dang Dai Er Ke Za Zhi, 11 (7), pp. 543-5.
9 Zubeifoier T, Aseio R, Bmdslev-Jensen C, et al. (2009),
"EAACI/GA(2)LEN/EDFAVAO guideline: management of urticana". Allergy, 64 (10), pp. l « 7 - 4 3 .
Ngdy nh&n bdi bdo:
Ngdy phdn biin nhdn xet bdi bdo:
Ngdy bdi bdo duac dang:
14/1111016 17/11/2016 01/03/2017
